| NPI | 1972501682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: NY 280178) |
| Additional Taxonomies | 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: OH 35-04-2582-P) |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2018-05-01 |